Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Functional use in BRS
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1 Durable Medical Equipment, Prsthetics, This is an educatinal cmpnent f Burgess Reimbursement System. Thughtfully designed t help yu accmplish mre with Medicare reimbursement infrmatin. Welcme Orthtics, and Supplies (DMEPOS) Functinal use in BRS 2013 The Burgess Grup LLC. All rights reserved.
2 DMEPOS Agenda/Learning Objectives Be familiar with the features and functinality related t DMEPOS in the fllwing Burgess Reimbursement System (BRS) mdules: Research Understand where t lcate data, define search criteria, and access plicy infrmatin Admin and Cnfigure - Understand the available cnfiguratin ptins and create custm reimbursement rules Price - Learn hw t apply custm reimbursement rules t claims and interpret the pricing results 2013 The Burgess Grup LLC. All rights reserved.
3 BRS Functinality - Research 2013 The Burgess Grup LLC. All rights reserved.
4 BRS Functinality - Research Research > Suppliers and Schedules > DMEPOS Fee Schedule View DMEPOS rates by: Access t: Features: ZIP Cde Date HCPCS Cde/Keywrd DMEPOS Rates (Fee Schedule) DMEPOS CB Rates DMEPOS Categries Effective Dates Rate/Plicy Flags Advanced Filtering Clumn Srting 2013 The Burgess Grup LLC. All rights reserved.
5 BRS Functinality - Research Research > Suppliers and Schedules > DMEPOS Fee Schedule Other features: Grid Settings Cde Lkup (e.g. DME Categry plicies) Exprt Data 2013 The Burgess Grup LLC. All rights reserved.
6 BRS Functinality - Admin 2013 The Burgess Grup LLC. All rights reserved.
7 BRS Functinality Admin Admin > Price Cnfiguratin DMEPOS Cmpetitive Bidding (CB) Optin ON/OFF Applies t all claims priced under the Prfessinal prvider type in the absence f a Reimbursement Rule Setting can be changed by users with an Admin permissin in BRS 2013 The Burgess Grup LLC. All rights reserved.
8 BRS Functinality - Cnfigure 2013 The Burgess Grup LLC. All rights reserved.
9 BRS Functinality Cnfigure Cnfigure > Prfessinal > Cnfigure Payment Plicies > Glbal Mdeling Flags DMEPOS Cnslidated Billing (CB) Optin ON/OFF Overrides the DMEPOS CB setting in BRS Admin when the rule is applied t a claim in BRS Price Setting can be changed by users with a Cnfigure Designer r Cnfigure Manager permissin in BRS 2013 The Burgess Grup LLC. All rights reserved.
10 BRS Functinality - Price 2013 The Burgess Grup LLC. All rights reserved.
11 BRS Functinality - Price Price > Prfessinal Example Overview Pricing examples invlve: A supplier lcated in ZIP cde (Tas, NM) The fllwing HCPCS cdes prvided n July 1, 2013 Line Item HCPCS/ Mdifier(s) Descriptin CB Item 1 E0100-RR Cane, adjustable with tip (Rental) N 2 E0250-RR-KH Hspital bed, with mattress (Rental, 1 st mnth) Yes 3 A4253-NU-KL Bld glucse/reagent strips (New, mail-rder) Yes Different beneficiary ZIP cdes Different DMEPOS CB ptins in BRS 2013 The Burgess Grup LLC. All rights reserved.
12 BRS Functinality - Price Price Example #1 Beneficiary ZIP = Unknwn BRS DMEPOS CB = On Basis f Payment: Supplier ZIP cde in Tas, NM (nt in a CBA) HCPCS: E0100 CB Item: N Methd: Fee Schedule HCPCS: E0250 CB Item: Yes Methd: Fee Schedule HCPCS: A4253 CB Item: Yes Methd: SPA 2013 The Burgess Grup LLC. All rights reserved.
13 BRS Functinality - Price Price Example #2 Beneficiary ZIP = in Sierra Vista, AZ (nt in a CBA) BRS DMEPOS CB = On Basis f Payment: Beneficiary ZIP cde HCPCS: E0100 CB Item: N Methd: Fee Schedule HCPCS: E0250 CB Item: Yes Methd: Fee Schedule HCPCS: A4253 CB Item: Yes Methd: SPA 2013 The Burgess Grup LLC. All rights reserved.
14 BRS Functinality - Price Price Example #3 Beneficiary ZIP = in Phenix, AZ (in a CBA) BRS DMEPOS CB = On Basis f Payment: Beneficiary ZIP cde HCPCS: E0100 CB Item: N Methd: Fee Schedule HCPCS: E0250 CB Item: Yes Methd: SPA HCPCS: A4253 CB Item: Yes Methd: SPA 2013 The Burgess Grup LLC. All rights reserved.
15 BRS Functinality - Price Price Example #4 Beneficiary ZIP = in Phenix, AZ (in a CBA) BRS DMEPOS CB = Off Basis f Payment: Beneficiary ZIP cde HCPCS: E0100 CB Item: N Methd: Fee Schedule HCPCS: E0250 CB Item: Yes Methd: Fee Schedule HCPCS: A4253 CB Item: Yes Methd: Fee Schedule 2013 The Burgess Grup LLC. All rights reserved.
16 BRS Functinality - Price Price Example Summary Line: 1 HCPCS: E0100-RR HCPCS Descriptin: Cane, adjustable with tip (Rental) Pricing Example Prvider ZIP Beneficiary ZIP CB Item CBA BRS DMEPOS Setting Price DMEPOS Pricing Methd Unknwn N N On $5.47 Fee schedule N N On $6.43 Fee schedule N Yes On $6.43 Fee schedule N Yes Off $6.43 Fee schedule 2013 The Burgess Grup LLC. All rights reserved.
17 BRS Functinality - Price Price Example Summary Line: 2 HCPCS: E0250-RR-KH HCPCS Descriptin: Hspital bed, with mattress (Rental, 1st mnth) Pricing Example Prvider ZIP Beneficiary ZIP CB Item CBA BRS DMEPOS Setting Price DMEPOS Pricing Methd Unknwn Yes N On $80.15 Fee schedule Yes N On $91.22 Fee schedule Yes Yes On $65.16 SPA Yes Yes Off $91.22 Fee schedule 2013 The Burgess Grup LLC. All rights reserved.
18 BRS Functinality - Price Price Example Summary Line: 3 HCPCS: A4253-NU HCPCS Descriptin: Bld glucse/reagent strips (New purchase, mail-rder) Pricing Example Prvider ZIP Beneficiary ZIP CB Item CBA BRS DMEPOS Setting Price DMEPOS Pricing Methd Unknwn Yes N On $10.41 SPA Yes N On $10.41 SPA Yes Yes On $10.41 SPA Yes Yes Off $10.41 Fee schedule 2013 The Burgess Grup LLC. All rights reserved.
19 DMEPOS Learning Objectives Recap Be familiar with the features and functinality related t DMEPOS in the fllwing Burgess Reimbursement System (BRS) mdules: Research Understand where t lcate data, define search criteria, and access plicy infrmatin Admin and Cnfigure - Understand the available cnfiguratin ptins and create custm reimbursement rules Price - Learn hw t apply custm reimbursement rules t claims and interpret the pricing results 2013 The Burgess Grup LLC. All rights reserved.
20 QUESTIONS? Cntact BRS Supprt at: p e The Burgess Grup LLC. All rights reserved.
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